Ischemic neurological injury is the most feared complication of spinal deformity surgery.In recent years, more attention has been paid to ischemic neurological injury during spinal deformity surgery including causes, risk factors, and prevention. The direct and indirect causes of ischemic neurological injury contains ligature of the segmental arteries, perioperative bleeding and excessive stretching or shortening of the spinal cord.Those patients at greatest risk for paraplegia following diagnosis of thoracic kyphosis or kyphoscoliosis, unilateral vessel ligation, perioperative hypotension, and extensive anterior and posterior surgery. Keeping reasonable mean arterial pressure and multimodal intraoperative monitoring may effectively prevent ischemic neurologic injury during surgery for spinal deformity.
Arteries ; Humans ; Ischemia ; physiopathology ; Kyphosis ; surgery ; Ligation ; Monitoring, Intraoperative ; Neurosurgical Procedures ; adverse effects ; Paraplegia ; Risk Factors ; Scoliosis ; surgery ; Spinal Cord Injuries

By searching relevant data from the PubMed database, Chinese National Knowledge Infrastructure (CNKI) database and Wanfang database, a comprehensive analysis and review regarding acupuncture for cerebral ischemia reperfusion injury (CIRI) in recent 10 years were performed. The results showed that acupuncture could inhibit the inflammatory reaction, reduce oxidative stress injury, restrain brain edema formation, inhibit apoptosis, promote neural and vascular regeneration, etc. Acupuncture methods used included electroacupuncture, scalp acupuncture, eye acupuncture and "consciousness-restoring resuscitation needling", etc. The existing problem was that the intervention action of acupuncture was mainly focused on inhibiting inflammatory reaction and oxidative stress injury, and the study on apoptosis and neural and vascular regeneration was needed. It is suggested that from the aspect of multiple target points, the intervention mechanism of acupuncture for CIRI should be systemically studied in the future, which could provide new idea for clinical diagnosis and treatment on ischemic cerebrovascular diseases.
Acupuncture Therapy ; history ; Animals ; Apoptosis ; Brain Ischemia ; history ; surgery ; History, 21st Century ; Humans ; Oxidative Stress ; PubMed ; Reperfusion Injury ; etiology ; history ; physiopathology ; therapy

To discuss the protective effect of aralosides (AS) on I/R-induced rat myocardial injury. The adult rat ventricular myocyte ischemia model was established through perfusion with sodium lactate perfusate and reperfusion with Ca(2+) -containing Tyrode's solution simulation. The cell contraction and ion concentration synchronization determination system was applied to detect the effect of AS on single I/R cell contraction and Ca2+ transients. According to the findings, AS could increase resting sarcomere length, contraction amplitude, ± dL/dt(max), calcium transient amplitude and speed of post-reperfusion myocardial cells (P < 0.05, P < 0.01), and decrease in time for achieving 90.0% of maximum relaxation, time for achieving peak value, resting calcium ratio, contraction period [Ca2+] i, time for achieving 50.0% of maximum relaxation and attenuation rate of intracellular calcium transient (P < 0.05, P < 0.01). Therefore, it is suggested that AS improved the post-reperfusion cell contraction and injury of calcium homeostasis.
Animals ; Aralia ; chemistry ; Biological Transport ; drug effects ; Calcium ; metabolism ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Male ; Muscle Contraction ; drug effects ; Myocardial Ischemia ; drug therapy ; metabolism ; physiopathology ; surgery ; Myocardial Reperfusion ; Myocytes, Cardiac ; drug effects ; physiology ; Rats ; Rats, Sprague-Dawley ; Saponins ; administration & dosage

No abstract available.
Angiogenesis Inhibitors/*therapeutic use ; Bevacizumab/*therapeutic use ; Choroid/*blood supply ; Ciliary Arteries/pathology ; Fluorescein Angiography ; Humans ; Intravitreal Injections ; Ischemia/*drug therapy/etiology/physiopathology ; Male ; Meningeal Neoplasms/surgery ; Meningioma/surgery ; Neurosurgical Procedures/*adverse effects ; Retinal Detachment/*drug therapy/etiology/physiopathology ; Subretinal Fluid ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/physiology ; Young Adult

OBJECTIVETo establish a general method of focal cerebral ischemia model in different varieties of mice.

METHODEach group of healthy adult KM and C57BL/6 mice were randomly divided into control group (n = 10) and MCAO group (n = 10). The mice in MCAO group were applied in the preparation of the MCAO model by intraluminal occlusion using monofilament. Twenty-four hours after operation,the neurologic function was evaluated,middle cerebral artery blood flow was monitored and the infarction volume was calculated by TTC staining, to evaluate the reliability of the model.

RESULTIn the MCAO group, the base value of the cerebral blood flow down of KM and C57BL/6 mice respectively was (81.65 ± 4.59)%, (83.68 ± 6.25)%. The neurological deficit score respectively was (2.30 ± 0.82), (2.50 ± 0.80). TTC staining can clearly show the infarction area, and relatively stable, 24 hours of the survival rate of KM and C57BL/6 mice were 100% and 80% respectively.

CONCLUSIONThe key link is the optimization and improvement of monofilament, temperature, anesthesia and so on. The modified intraluminal occlusion of MCAO using monofilament is a kind of reliable and simple method to establish experimental cerebral ischemia model in mice.

Animals ; Blood Flow Velocity ; Brain ; blood supply ; pathology ; physiopathology ; Brain Ischemia ; complications ; physiopathology ; Cerebrovascular Circulation ; Disease Models, Animal ; Infarction, Middle Cerebral Artery ; complications ; physiopathology ; Male ; Mice, Inbred C57BL ; Middle Cerebral Artery ; pathology ; physiopathology ; surgery ; Nervous System Diseases ; etiology ; physiopathology ; Species Specificity

OBJECTIVETo assess the effects of warm ischaemia time (WIT) on renalfunction after laparoscopic partial nephrectomy (LPN) for renal masses in patients.

METHODSFrom January 2010 to December 2012, 39 patients treated with LPN for a single T1 renal tumor were enrolled in this prospective study. There were 24 male and 15 female patients. Their age was (58 ± 10) years old, and their body mass index was (27 ± 3) kg/m(2). The mean operation time was (132 ± 12) minutes, and the mean WIT was (29 ± 8) minutes. Clinical parameters, the single glomerular filtration rates (sGFR) were compared before the operation and after 3 and 12 months in order to observer the effects on renal function and find the factors predicting the renal function impairment.

RESULTSThere were significant differences between 3, 12 months after the operation ((26.8 ± 5.6) ml/min and (28.6 ± 5.6) ml/min, respectively) and preoperation ((31.9 ± 6.3) ml/min) in sGFR (F = 4.882 and 5.511, both P < 0.05). And there were significant negative correlations between the sGFR in 3 and 12 months after the operation and WIT (r = -0.569, P = 0.000 and r = -0.448, P = 0.004) . The preoperative sGFR (β = 0.260, 95%CI:0.089-0.431) and WIT (β = 0.369, 95%CI:0.189-0.555) were independent predictors for function decline of the operated kidney (both P < 0.05). The analysis showed that the effects of WIT within 30 minutes on renal function is relatively small. Longer WIT was associated with lower postoperative sGFR values (F = 22.128 and 20.552, both P = 0.000) .

CONCLUSIONSFor the LPN operation, the longer of the WIT, the more serious of renal function damage. sGFR is an accurate measurement to assess the renal damage. Every effort should be made to minimise WIT during LPN, and the limit of 30 minutes should be not exceeded.

Aged ; Female ; Humans ; Kidney ; physiopathology ; Kidney Function Tests ; Kidney Neoplasms ; surgery ; Laparoscopy ; Male ; Middle Aged ; Nephrectomy ; Operative Time ; Prospective Studies ; Warm Ischemia ; adverse effects

OBJECTIVE: To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI). MATERIALS AND METHODS: This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method. RESULTS: TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively. CONCLUSION: Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.
Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Endovascular Procedures/adverse effects/*methods ; Female ; Foot/*blood supply ; Humans ; Ischemia/physiopathology/*surgery ; Limb Salvage ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Survival Rate ; Treatment Outcome ; Wound Healing/*physiology

OBJECTIVETo investigate the efficacy and safety of combined common femoral artery (CFA) endarterectomy with superficial femoral artery (SFA) stenting plus Shuxuening Injection infusion in patients with complex multifocal arterial steno-obstructive lesions of the lower extremities.

METHODSFrom March 2006 to March 2011, 104 lower limbs in 96 patients with multilevel peripheral arterial steno-occlusive disease, involving SFA as well as CFA and deep femoral artery (DFA) orifice, were treated by combined surgical with endovascular therapy, such as SFA stenting as an adjunct to CFA endarterectomy and patch angioplasty with the great saphenous vein. Before the end of the operation, 20 mL of Shuxuening Injection was infused through the catheter located in the treated artery. Technical and hemodynamic success, as well as primary and primary-assisted patency, was determined according to the Society for Vascular Surgery Guidelines. During follow-up, clinical status assessment, ankle-brachial index (ABI) test, and duplex Doppler ultrasound were administered every 6 months, and computed tomography angiography or magnetic resonance angiography was performed at 12, 24, and 36 months after discharge.

RESULTSAll patients underwent successful combined CFA endarterectomy with SFA stenting treatment. The average ABI after the combination treatment increased from pretreatment of 0.32±0.21 to 0.82±0.24 (P<0.01). No perioperative death and major limb amputations occurred. The mean duration of follow-up for 104 limbs from 96 patients was 1,180 days (range, 196-2,064 days). During follow-up, 5 patients died due to myocardial infarction, cerebral infarction, or pneumonia, and 5 patients were lost to follow-up. There were 21 cases (21.4%) of restenosis, with 15 that occurred in-stent and 6 near the distal end of the stent. A total of 18 (18.3%) reinterventions were performed, including 6 balloon angioplasty, 8 restenting procedures, 2 bypass surgeries, and 2 major limb amputations. The primary patency rates were 92.2%, 76.8%, and 61.3% at 12, 24, and 36 months, respectively, while the primary-assisted patency rates were 94.4%, 83.2%, and 75.6% at 12, 24, and 36 months, respectively.

CONCLUSIONThe combined CFA endarterectomy with SFA stenting plus Shuxuening Injection infusion appears to offer a safe, less invasive, and effective treatment option to patients with chronic lower extremity ischemia due to complex multifocal peripheral artery disease.

Aged ; Aged, 80 and over ; Chronic Disease ; Drugs, Chinese Herbal ; administration & dosage ; pharmacology ; therapeutic use ; Endarterectomy ; Female ; Femoral Artery ; drug effects ; physiopathology ; surgery ; Follow-Up Studies ; Hemodynamics ; drug effects ; Humans ; Infusions, Intra-Arterial ; Ischemia ; drug therapy ; physiopathology ; surgery ; Leg ; blood supply ; physiopathology ; Male ; Middle Aged ; Stents

Management of ischemic mitral regurgitation (MR) is challenging. The aim of this study was to investigate long-term clinical and echocardiographic results of restrictive mitral annuloplasty for ischemic MR. From 2001 through 2010, 96 patients who underwent myocardial revascularization with restrictive mitral annuloplasty using a vascular strip for ischemic MR were analyzed. Patients were stratified into two groups based on left ventricular ejection fraction (LVEF): group I, n = 50, with LVEF > 35% and group II, n = 46, with LVEF < or = 35%. The early mortality rate was 2.1% (2/96) and the late cardiac mortality rate was 11.5% (11/96). MR grade was reduced at discharge (0.8 +/- 0.7) but increased during follow-up (1.1 +/- 0.8, P = 0.001). There was no intergroup difference in terms of freedom from recurrent MR > or = moderate eight years after surgery (94.1% +/- 5.7%, group I vs 87.8% +/- 7.2%, group II; P = 0.575). NYHA functional class (odds ratio [OR], 2.2; P = 0.044) and early postoperative residual MR > or = mild (OR, 25.4; P < 0.001) were independent predictors of recurrent MR. Restrictive mitral annuloplasty using a vascular strip is effective in ischemic MR. It is important to avoid early postoperative residual MR.
Aged ; Aged, 80 and over ; Coronary Artery Disease/mortality/*surgery ; Echocardiography ; Female ; Follow-Up Studies ; Heart Valve Prosthesis Implantation ; Humans ; Male ; Middle Aged ; Mitral Valve/physiopathology/*surgery ; Mitral Valve Annuloplasty/*methods ; Mitral Valve Insufficiency/mortality/*surgery ; Myocardial Ischemia/mortality/*surgery ; Myocardial Revascularization ; Stroke Volume ; Treatment Outcome ; Vascular Surgical Procedures

Brief episodes of cerebral hypoxia-ischemia cause transient ischemic tolerance to subsequent ischemic events that are otherwise lethal. This study was conducted to evaluate the protective effect of hypoxic preconditioning on hypoxic-ischemic injury in the neonatal rat and the persistence of a protective window after hypoxic preconditioning. The rats were preconditioned with hypoxia (8% oxygen, 92% nitrogen) for three hours, subjected to ischemia using ligation of the right common carotid artery, and then exposed to another three hours of hypoxia. Using proton magnetic resonance spectroscopy, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling (TUNEL) staining, and morphologic scores, this study shows that hypoxic preconditioning 6-hr to 1-day before hypoxic-ischemic injury increases survival rates and has neuroprotective effects against subsequent hypoxic-ischemic injury. The mechanism of the protective effects of hypoxic preconditioning in the newborn rat brain may involve downregulation of apoptotic cell death.
Animals ; Animals, Newborn ; Apoptosis ; Aspartic Acid/analogs & derivatives/analysis ; Brain/metabolism/pathology ; Carotid Arteries/surgery ; Creatine/analysis ; Hypoxia-Ischemia, Brain/metabolism/pathology/*physiopathology ; In Situ Nick-End Labeling ; Ischemic Preconditioning/*methods ; Magnetic Resonance Spectroscopy ; Rats ; Rats, Sprague-Dawley ; Survival Rate